Update on the Affordable Care Act

September 2012, Vol 43, No. 8

Print version: page 26

With the Supreme Court's decision to uphold the Patient Protection and Affordable Care Act, several key provisions for Americans — and the psychologists who serve them — are moving forward, with many portions fully implemented in 2014.

The Affordable Care Act is not slated for full implementation until 2015, but several insurance market reforms are already in effect. Americans no longer have lifetime and annual limits on visits to their doctors, their insurance can no longer be canceled retroactively and their children can no longer be denied coverage for pre-existing conditions.

The process of implementing the law is still unfolding, but here are answers to questions psychologists have about how the law will affect them:

What does the Supreme Court's ruling on the Affordable Care Act mean for my practice?

The law's most important implication is that it provides more Americans with insurance coverage, although the Supreme Court's decision changes the number who will ultimately be insured. Before the decision, 32 million people were projected to become insured under the Affordable Care Act, mainly through new state-established health insurance exchanges and the expansion of Medicaid. However, the court ruled that the Medicaid expansion should be optional — a decision that will reduce the number who are insured, according to the nonpartisan Congressional Budget Office.

Also important is that the law provides Americans with access to mental health and substance use services at parity. As of Jan. 1, 2014, mental health and substance use disorder services are part of the essential benefits packages that all qualified health plans will offer through state health insurance exchanges. While the law does not specify benefits requirements, states will establish "benchmark" and "benchmark equivalent" plans with benefits levels that qualified health plans must meet.

Ultimately, the influx of people into the health insurance market (private and Medicaid), as well as the requirement that mental health services be offered at parity, has great potential to increase consumers' use of mental health and substance use treatment services.

How will the law affect the way I provide services?

Psychologists will provide services to enrollees in health-insurance exchange-qualified health plans much in the same way they provide services through the employer-based system. For example, psychologists will negotiate payment rates with exchange plans, as well as with plans in the private market. Depending on how a state implements its health insurance exchange, psychologists may have new opportunities to provide preventive services under the Affordable Care Act, and to participate in integrated-care systems.

What opportunities for psychologists are supported by the new law?

The law embraces the concept of integrated care. APA's Practice Organization (APAPO) continues to work to ensure that psychologists have the opportunity to participate in new integrated-care initiatives, which are fast developing both in federal health programs and in the private market.

In implementing the Affordable Care Act and establishing health insurance exchanges, states may take a lead from the major federal integrated-care initiative, the expanded Medicare Accountable Care Organization (ACO) model. Under this model, providers will coordinate services to specified groups of Medicare beneficiaries, and share any savings from such coordinated efforts. Psychologists may fully participate in these Medicare ACOs.

Psychologists are also included in a number of Affordable Care Act initiatives that promote integrated care. For example, they may participate in community interdisciplinary, interprofessional health teams that promote primary-care practices, work within a consortium of health-care providers to deliver comprehensive and integrated-care services for low-income populations, and participate in health-care homes as part of health teams.

The law creates another important benefit for psychologists: Health plans may no longer discriminate against psychologists and other health-care providers with respect to plan participation.

What happens next?

If the White House and Congress change parties following the November elections, there could be legislative or regulatory changes to the Affordable Care Act, but it is highly unlikely the law would be overturned. Regardless, states need to move forward to implement the law's provisions. They need to decide whether to establish an insurance exchange or default to a federally run alternative; whether to expand their Medicaid programs; and how quickly and effectively they can implement enrollee eligibility systems.

What are APA and APAPO doing to protect psychologists as the law is being implemented?

The APA Practice Directorate and APAPO continue to ensure that professional psychology is well represented and that psychologists are positioned to participate fully in the evolving health-care system. Specifically, we are monitoring any federal legislation and regulations related to health-care reform, and continuing to look for opportunities to protect and promote the interests of our members.

We are also working with state associations to address issues related to the state implementation of the law, including the Medicaid expansion. As issues related to the law unfold, we will continue to provide our members with information about the impact on practitioners in all settings.